Tunica vaginalis flap is superior to inner preputial dartos flap as a waterproofing layer for primary TIP repair in midshaft hypospadias

Babu, Ramesh; Sekar, Hariharasudhan

doi:10.1016/j.jpurol.2012.10.022

Cited by 30 publications

(31 citation statements)

References 17 publications

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“…Post-operatively, urethrocutaneous fistula is the most common complication. [567] To decrease fistula rate, an additional tissue cover after neourethra reconstruction has been described using transverse island dorsal subcutaneous flap,[8] de-epithelialized skin flaps,[910] lateral dartos flap,[11] double dartos flaps,[1213] double breasted de-epithelialized penile skin flap[14], tunica vaginalis[1516], and corpus spongiosum. [51718] The use of corpus spongiosum as an intervening layer over the neourethra is less frequent.…”

Section: Introductionmentioning

confidence: 99%

Outcome of tubularized incised plate urethroplasty with spongioplasty alone as additional tissue cover: A prospective study

et al. 2014

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Introduction:Additional cover after neourethra formation to decrease the fistula rate, has been described using the dartos, tunica, denuded skin and corpus spongiosum. The use of corpus spongiosum alone to cover the neourethra is infrequent. The objective of this study was to evaluate the efficacy of spongioplasty alone as an intervening layer in the prevention of urethral fistula following tubularized incised plate urethroplasty (TIPU).Materials and Methods:A prospective study was performed including 113 primary hypospadias cases undergoing TIPU with spongioplasty from June 2010 to March 2012. Correction of chordee was carried out by penile degloving alone in 5, mobilization of urethral plate with spongiosum in 22 and combination of both in 45 cases. Intra-operatively, spongiosum was taken to be poorly developed if it was thin and fibrous, moderate if good spongiosal tissue with good vascularization and well-developed if healthy robust spongiosum, which became bulkier than native spongiosum after tubularisation. Spongioplasty was done in a single layer after mobilization of spongiosum, starting just proximal to the native meatus and into the glans distally.Results:The mean age of the patients was 11.53 years. The type of hypospadias was distal, mid and proximal in 81, 12 and 20 cases respectively. Spongiosum was poorly developed in 13, moderate in 53 and well-developed in 47 cases. The mean hospital stay was 8-10 days and follow-up ranged from 6 months to 2 years. Urethral fistula was seen in six patients (11.3%) with moderate spongiosum (distal 1, mid 1 and proximal 4), and three (23.03%) with poorly developed spongiosum (one each in distal, mid and proximal) with an overall 7.96% fistula rate. None of the patients with well-developed spongiosum developed a fistula. Poorer spongiosum correlated with a greater number of complications (P = 0.011). Five out of thirteen cases with poor spongiosum (38.46%) had proximal hypospadias, i.e. more proximal was the hypospadias, poorer was the development of the spongiosum (P = 0.05). Meatal stenosis was seen in two patients (1.76%) with proximal hypospadias, one with moderate and the other with poorly developed spongiosum. More proximal was the hypospadias, greater were the number of complications (P = 0.0019).Conclusion:TIPU with spongioplasty reconstructs a near normal urethra with low complications. Better developed and thicker spongiosum results in lower incidence of fistula and meatal stenosis. More proximal hypospadias is associated with poorer spongiosum. We recommend spongioplasty to be incorporated as an essential step in all patients undergoing tubularized incised-plate repair for hypospadias.

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Section: Introductionmentioning

confidence: 99%

Outcome of tubularized incised plate urethroplasty with spongioplasty alone as additional tissue cover: A prospective study

et al. 2014

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“…Of 1928 databases articles titles and 57 trial register titles screened, 1269 abstracts were reviewed, 31 full text were reviewed, and 9 articles [12][13][14][15][16][17][18][19][20] met our inclusion criteria and were included in our meta-analysis ( Fig. 1).…”

Section: Literature Selection and Study Characteristicsmentioning

confidence: 99%

A meta-analysis of tunica vaginalis fascia versus dartos fascia to prevent postoperative urethrocutaneous fistula in hypospadias and fistula repair

Yang

Xuan

et al. 2020

Preprint

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Background: Urethrocutaneous fistula (UCF) is the commonest postoperative complication in hypospadias and fistula repair. Several flap procedures have been recommended to decrease this complication rate, but no single flap procedure is ideal. The aim of this study was to compare the outcome of tunica vaginalis fascia (TVF) and dartos fascia (DF) as intermediate layers in prevention of the formation of UCF. Methods: We searched PubMed, EMBASE, the Cochrane Library and Web of Science for comparative studies up to July 1st, 2019. Studies were selected by the predesigned inclusion criterias. The primary outcomes was UCF incidence. Results: The pooled RR with 95% CI were calculated. We extracted the relevant informations from the included studie. 9 comparative studies were included The RR of UCF rate for TVF was 0.21 (95% CI: 0.09-0.51, P=0.0005) compared with DF in hypospadias and fistula repair. For other postoperative complications, the RR was 0.87 (0.28-2.70, P=0.80), 1.33 (0.41-4.35, P=0.64) and 0.17 (0.03-0.88, P=0.04) for meatal stenosis/ urethral stricture, glans dehiscence/ wound dehiscence and skin necrosis, respectively. Conclusions: This meta-analysis reveals that TVF is a better option in TIP repair as compared to DF in terms of decreasing the incidence of the UCF and skin necrosis. But there is limited for other hypospadias operative techniques and fistula repair. registration number: PROSPERO CRD42019148554

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“…2 Different tissues have been described in the literature as an intermediate layer to cover the neourethra using dorsal, 3 lateral, single or double 4 dartos flaps, ventral based dartos flap, 5 scrotal dartos flap, 6 spongioplasty 7-9 and tunica vaginalis flaps. 10,11 The corpus spongiosum provides a well vascularized, spongy protective covering to the normal urethra that can prevent diverticula and facilitate catheterization if required. It may aid in the natural propulsion of urine and semen.…”

Section: Introductionmentioning

confidence: 99%

Spongioplasty with Dartos Flap Coverage in the Snodgrass Technique of Hypospadias Repair

Das

Hasina

Huq

et al. 2020

J. Bangladesh Coll. Phys.

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Objective: The aim of the study is to evaluate the role of spongiosal tissue with dartos flap coverage for preventing Urethrocutaneous Fistula (UCF) formation in the Snodgrass technique. 19 patients, shallow in 13 patients and no groove noticed in 3 patients. Sixteen patients had narrow urethral plate (<8mm) and 19 patients had adequate urethral plate (>8mm). patients (14.28%), meatal stenosis in two patients (5.71%), and partial glanular dehiscence in one patient. Materials and Methods: It is a prospective study, performed on 35 patients of mid penile and distal hypospadias aged 15 months to 144 months who underwent urethroplasty in the Snodgrass technique using spongiosal tissue and dartos flap for neourethral coverage. Results: Among 35 patients, Age ranged from 15 months to 144 months (mean 85.94 months). Chordee was corrected by penile degloving alone in 11 patients, partial mobilization of urethral plate with spongiosum in 20 patients and 4 patients required dorsal plication. Glans groove was deep in Urethrocutaneous Fistula (UCF) was encountered in five Conclusions: Approximation of spongiosal tissue along with dartos flap as the intermediate layer for neourethral coverage reduces fistula formation.

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Tunica vaginalis flap is superior to inner preputial dartos flap as a waterproofing layer for primary TIP repair in midshaft hypospadias

Cited by 30 publications

References 17 publications

Outcome of tubularized incised plate urethroplasty with spongioplasty alone as additional tissue cover: A prospective study

Outcome of tubularized incised plate urethroplasty with spongioplasty alone as additional tissue cover: A prospective study

A meta-analysis of tunica vaginalis fascia versus dartos fascia to prevent postoperative urethrocutaneous fistula in hypospadias and fistula repair

Spongioplasty with Dartos Flap Coverage in the Snodgrass Technique of Hypospadias Repair

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